Accessibility Panel

Research shows that the most common risk factors for homelessness include:

• History of institutional care and foster group, 
• Childhood physical, emotional and sexual abuse,
• Neglect in childhood,
• Substance abuse in the family of origin
• Homelessness in the family of origin
• Frequent use of inpatient psychiatric and medical services
• Low levels of education,
• High use of medical services and inpatient psychiatric  
• Low levels of education,
• Substance abuse,
• Mental illness.

Many of these risk aspects have their origins in childhood and teenage years and seem to be the reason for the development of major difficulties later in life. Although these risk factors are well-known, one of the most common sequelae of these experiences — traumatic brain injury — often goes unnoticed among homeless persons.

How Does TBI Occur in vagrant people?

After performing over 3,000 complete psychiatric assessments of persons experiencing homelessness, most of whom had spent the past year or more in a shelter, on the street, drop-in center, or other transitional settings, a prominent commonality became evident. At least half of the patients suffered from blows to the head sustained due to severe childhood physical abuse, childhood motor vehicle accidents, or accidents and falls while playing sports. 

Most of the persons that reported blows to the head also suffered from difficulties with memory, attention, and impulse control, often with associated placement in special education classes, either for academic failure or behavioral difficulties. Only a few reported  finished high school, and those who joined the military were unable to finish their initial tour of duty due to behavioral and cognitive problems

These individuals usually reported that the injuries they suffered as children as well as their neuropsychological sequelae frequently went untreated and unreported as a result of abusive parents trying to conceal their injuries as well as the underprivileged conditions in which they were raised, with no access to inexpensive medical care or health insurance coverage.

Homelessness is comorbid with all these conditions: psychiatric symptomatology, substance abuse and school failure or placement in special education, and captivity. Yet no protocol is followed to routinely screen those facing homelessness for traumatic brain injury (TBI) or its neuro-psychological sequelae.

At present, the impact of TBI and cognitive dysfunction on the cost of homelessness has not been calculated since the research that would bring those costs to light has yet to be undertaken. In many cities, homeless persons live on the streets, in hospital shelter, detox centers, and jails in a cyclical fashion at great cost to society and themselves.

In terms of medical care, homeless persons are likely to use the most expensive interventions: emergency settings, detoxification facilities, and psychiatric units. On average, studies report that homeless persons spend four more days in hospital each year than nonhomeless people.

Studies show that homeless persons also spend a disproportionate amount of time in jail and prison. The study estimated that approx. 90% of these costs comprise medical care for this vulnerable population. Additionally, homeless lodgings cost far more on average than permanent housing.

One reason for the frequent use of high-cost medical services by homeless persons may be the ease of admission. In many cities in the U.S, for example, hospital emergency departments cannot decline uninsured persons' medical care. At the same time, in an outpatient setting, those who are unable to pay will not be seen.

Identification of cognitive dysfunction in homeless persons can increase their ability to obtain SSI/SSD disability claims, which assures stable health insurance in the form of Medicaid and/or Medicare. It may also limit inappropriate emergency room use and avoidable hospitalizations.